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Arizona home-care choices
Last updated: 15 October 2026
Arizona Long Term Care System (ALTCS) offers two ways to direct paid care at home: Agency with Choice and Self-Directed Attendant Care (SDAC). They differ mainly in who employs and manages the worker.
Bottom Line
Agency with Choice: a provider agency is the legal employer. The ALTCS member or a designated individual representative helps select and manage the worker. SDAC: the member or legal guardian is the legal employer; a Fiscal Employer Agent handles paychecks and payroll taxes. Neither option gives the family an automatic salary or a new grant. Ask the ALTCS case manager which option fits the member’s approved services and ability to direct care.
Start Here
- Already on ALTCS? Call your case manager. Ask for the member-directed options review before anyone quits a job or starts unpaid onboarding.
- Not on ALTCS? Use the official ALTCS overview to start the medical and financial eligibility process.
- Have a relative in mind? Give the case manager the relationship, whether that person is a legal guardian or representative, and what tasks and schedule are needed.
Which Option Fits Your Household?
| Question | Agency with Choice | Self-Directed Attendant Care |
|---|---|---|
| Legal employer | Approved provider agency | Member or legal guardian |
| Who chooses worker? | Member selects; agency formally hires | Member or guardian recruits and hires |
| Payroll | Agency handles employer payroll | Fiscal Employer Agent processes payroll |
| Services within model | Approved attendant care, personal care, homemaker, or habilitation | Approved attendant care, with limited skilled tasks only under special rules |
| Best reason to ask | Want to direct day-to-day care with agency support | Want to take on the full employer role |
These models deliver approved care; they are not extra benefits. The official AHCCCS decision tree also compares traditional agency care.
Who Can Use These Options in Arizona?
The Arizona Health Care Cost Containment System (AHCCCS) runs ALTCS, the state Medicaid long-term-care program. ALTCS requires medical and financial eligibility. These member-directed options are for people living in their own homes.
Nursing facility and assisted-living residents cannot assume these in-home employment options apply. For other settings, see our Arizona assisted living guide.
Agency with Choice policy covers ALTCS elderly/physically disabled members, Division of Developmental Disabilities (DDD) members, and applicable fee-for-service or Tribal ALTCS programs. SDAC policy is narrower: it covers elderly/physically disabled ALTCS and Tribal ALTCS fee-for-service arrangements, not every DDD service model. Ask the case manager which model the plan or tribal program offers. County networks differ; these are not county grants.
For help with the first application, see the Arizona benefits portals guide. Already approved members should start with the case manager instead of submitting a second ALTCS application.
Agency with Choice: Agency Employer, Member Direction
Under AHCCCS Policy 1310-A, the provider agency is the legal employer of the direct care worker. The member is the day-to-day managing employer, often described as co-employment. The member and agency sign a partnership agreement.
The member selects a worker from the agency or proposes someone the agency may hire. The agency makes the legal hiring decision. The member can dismiss that person from their own care, not from the agency’s payroll.
Members can set schedules, supervise care, and ask for needed training. The agency handles legal employment, basic training, payroll, and agency oversight. The AHCCCS Agency with Choice FAQ says this option is voluntary.
If the member cannot direct care alone, an individual representative can act for them. A legal guardian automatically fills this role. But that representative cannot also be the member’s paid direct care worker under Agency with Choice. This matters when one child hopes to direct care and earn wages. The representative form sets out this restriction.
Practical example: A member wants her adult daughter to give approved home care. If the member can choose and direct the worker, Agency with Choice may allow the agency to consider hiring the daughter. If the daughter must act as the formal individual representative instead, she cannot also fill the paid worker role under that model. Have the case manager check the actual family roles before anyone signs forms.
Self-Directed Attendant Care: Member as Employer
Under AHCCCS Policy 1320-A, the member or legal guardian becomes the legal employer. The member chooses, interviews, hires, supervises, schedules, and, when needed, dismisses the attendant care worker. This also means more employer work.
A Fiscal Employer Agent (FEA) helps with employment paperwork, taxes, withholding, and paychecks. The FEA does not assume the employer role. The member must check work records and keep a backup plan.
SDAC generally covers the authorized attendant care service rather than all the services named under Agency with Choice. State rules allow some limited skilled tasks only when the specific SDAC conditions are met. Do not assume a worker can provide regular licensed nursing care under the SDAC label. The official member manual explains duties and setup.
To use SDAC, a person must be able to direct care or have a legal guardian who can do so. The legal guardian cannot be the member’s paid worker and must be present with the member when SDAC services are provided. A spouse cannot be paid through SDAC for providing care to their partner. Parents of minor children also cannot be paid SDAC workers. Other relatives may be eligible.
A member and worker must complete the required agreements and FEA steps before paid services begin. Review the SDAC forms and checklist with the case manager. If employer tasks or arranging backup care would be too hard, Agency with Choice or traditional agency care may fit better.
Can You Hire a Son, Daughter, Spouse, or Guardian?
| Person or role | What to check |
|---|---|
| Adult child or other relative | May be considered if qualified, the service is approved, and the person has no barred representative role |
| Agency with Choice representative | Cannot also be paid worker for that member |
| SDAC legal guardian | Acts as employer; cannot also be paid worker |
| Spouse | Cannot be paid through SDAC; ask about the separate ALTCS spouse-paid pathway |
| Parent of a minor child | Not a paid worker under these member-directed policy provisions; ask DDD/plan about other applicable current rules |
A guardian, individual representative, and eligibility authorized representative have different roles. For broader caregiver routes, see our Arizona family caregiver guide.
A spouse interested in paid care must ask the ALTCS case manager about the separate spouse-paid arrangement and its limits. Do not use SDAC to bypass a family-role restriction. These rules concern pay under specific models.
What Care and Hours Will ALTCS Pay For?
The service model does not set the number of paid hours. The ALTCS case manager assesses needs and develops a service plan. The plan sets the authorized service types, tasks, and time. Neither model permits double payment for the same hours. AHCCCS policies say members may still receive other medically necessary ALTCS services. Ask the case manager which services remain covered alongside this care model.
Neither option promises an hourly wage, full-time job, family stipend, or reimbursement for every hour a relative spends helping. Agency wages depend on the employing agency and approved job. Under SDAC, the FEA handles worker pay within the authorized arrangement. Request wages, authorized hours, pay dates, and EVV rules in writing.
Arizona uses electronic visit verification (EVV) for covered in-home services. It records who gave care and when. Bad records can delay pay. The AHCCCS EVV instructions explain the system and its current resources.
If care needs rise, ask the case manager for a reassessment before adding paid hours. AHCCCS lists planned updates to its Home and Community Based Services Needs Tool and extraordinary care review process for late 2026. A posted future implementation timeline is not proof that a new hour rule already governs this member. Check the ALTCS policy updates when the service plan is reassessed.
How to Choose and Start Without Losing Care
- Confirm ALTCS and home setting. If not enrolled, start through the ALTCS application route. Medical and financial reviews are required; approval of ALTCS comes before selection of covered in-home services.
- Review the service plan. With the case manager, name the needed tasks and current approved hours. Ask which of those services can use each model.
- List the worker’s family roles. Say whether the proposed paid worker is also a legal guardian, individual representative, or spouse. This can change the model available.
- Choose your level of control. With Agency with Choice, ask which agency can employ the worker and request the partnership agreement. With SDAC, ask for the FEA contact, employer paperwork, and a backup plan.
- Finish training and onboarding. Confirm the worker is accepted, agreements are signed, EVV is ready, and the start date is approved. Do not assume that earlier unpaid care becomes payable afterward.
- Plan for missed shifts. Keep a backup worker or other safe coverage plan. The SDAC contingency form helps set out the response to missed or short visits.
If you cannot reach your assigned worker, use the ALTCS office contacts or call 1-888-621-6880 to find the correct eligibility or service contact. County and tribal provider networks vary; do not rely on an unverified statewide list of agencies willing to hire a particular relative.
Documents and facts to have ready
- ALTCS ID, health plan or Tribal ALTCS details, and case manager contact.
- Current service plan, approved hours, and a list of care gaps.
- Proposed worker’s name, relationship, location, and availability.
- Any guardianship or individual representative papers.
- Training, employment, and work-eligibility documents requested by the agency or FEA.
- A way to record visits and a safe backup caregiver plan.
For the larger question of paying for in-home help beyond this employer choice, use our Arizona home-care payment guide.
Reality Checks, Delays, and Denials
Neither model guarantees a worker. Relatives need hiring approval. Agencies may lack staff, while SDAC needs full employer oversight. Prior informal care does not start payroll.
Common mistakes include calling these models grants, treating the FEA as the member’s employer, asking a legal guardian to be a paid SDAC worker, assuming a spouse can be paid under SDAC, and logging hours that were never approved. Also, choosing a model does not remove medical-necessity or safety reviews.
If services are delayed: tell the case manager exactly which essential tasks are not covered and when the missed visits occurred. Ask for an immediate safe coverage plan and a review of whether traditional agency care would protect the member while paperwork is completed.
If services or hours are denied or reduced: request the written decision, reason, and appeal instructions. For a health-plan service decision, contact the plan’s grievance and appeals office. Eligibility appeals follow the agency that made the eligibility decision; tribal or fee-for-service cases may use AHCCCS channels. See the official AHCCCS appeals instructions. Follow the deadline on your notice rather than guessing from a general article.
Missed visits may warrant a grievance; denied care may warrant an appeal. Keep notices and call records. For respite and non-pay caregiver support, see our Arizona aging agencies directory lists local help. If ALTCS is not available, our Arizona disability help guide explains other assistance.
Three Phone Scripts
Call your ALTCS case manager
“I receive ALTCS at home. Can we compare Agency with Choice and Self-Directed Attendant Care for my approved services? Who can be my paid worker, and which forms come next?”
Call an Agency with Choice provider
“I want to select a family caregiver. Are you in my ALTCS network? Can you hire this relative, and what training, wage, paperwork, and start-date rules apply?”
Call the case manager about SDAC
“Who will be the legal employer in my situation? I need the Fiscal Employer Agent contact, worker forms, EVV training, and a backup plan before care starts.”
Resumen en español
En Arizona, Agency with Choice permite que la agencia sea el empleador legal y que la persona con ALTCS participe en elegir y dirigir al cuidador. En Self-Directed Attendant Care (SDAC), la persona afiliada o su tutor legal es el empleador; un agente fiscal maneja la nómina. Estas opciones no son subsidios en efectivo. Deben existir servicios y horas autorizados. En SDAC no se paga al cónyuge ni al tutor legal como cuidador. Pida al administrador de casos de ALTCS que revise las reglas, los formularios y cómo apelar una denegación. Teléfono ALTCS: 1-888-621-6880.
Frequently Asked Questions
Is Agency with Choice the same as Self-Directed Attendant Care?
No. In Agency with Choice, the provider agency is the legal employer and the member directs day-to-day care. In SDAC, the member or legal guardian is the legal employer, with payroll help from a Fiscal Employer Agent.
Can my adult child be my paid ALTCS caregiver?
Possibly, if ALTCS authorizes the service and the relative meets hiring rules. An Agency with Choice individual representative cannot also be the paid worker, and an SDAC legal guardian cannot be the paid worker.
Can my spouse get paid through SDAC?
No. Arizona SDAC policy bars payment to a spouse under SDAC. Ask the ALTCS case manager about the separate spouse-paid caregiver pathway and its current rules.
Do I need an approved service plan first?
Yes. The ALTCS case manager must assess needs and authorize covered services and hours. Selecting an employer model does not approve extra hours or make earlier informal care payable.
What if the worker stops coming?
Contact the worker arrangement and ALTCS case manager, use the agreed backup plan, and report missed care. If a plan denies or reduces services, request written notice and follow the official appeal instructions.
About This Guide
This guide uses official Arizona Medicaid policies, member materials, and other responsible sources linked in the article.
Editorial note
This guide is produced based on our Editorial Standards using official and other high-trust sources, regularly updated and monitored, but not affiliated with any government agency and not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Please note that despite our careful verification process, errors may still occur. Email info@grantsforseniors.org with corrections and we will respond within 72 hours.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, and availability can change. Readers should confirm current details directly with the official program before acting.
Last updated: 15 October 2026 · Next review: 13 January 2027
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